Healthcare-Associated Clostridium difficile Infections in Canadian Acute-Care Hospitals – Surveillance Report January 1st, 2007 to December 31st, 2012

Executive Summary

Clostridium difficile, commonly called C. difficile (CDI), is a bacterium that causes diarrhea and other serious intestinal conditions. It is the most common cause of infectious diarrhea in hospitals and long-term care facilities in Canada. C. difficile causes disease by releasing toxins that destroy the lining of the bowel which, in turn, causes bloating and frequent, watery diarrhea.  Other symptoms such as severe abdominal pain and tenderness, and/or fever may occur. In rare instances, C.difficile can progress to more severe, life-threatening disease such as perforation of the bowel or toxic megacolon (or enlargement of the colon). People can also acquire C.difficile without developing CDI and remain without symptoms.

Hospitalised patients can acquire C.difficile if they touch surfaces contaminated with feces (e.g. toilet seats, bedrails, door handles, soiled linens, etc.), and then touch their mouths.  C.difficile may also spread from patient to patient via the contaminated hands of health care workers.  The population at risk of acquiring CDI includes the elderly, or people with certain antibiotics exposure, immunocompromising conditions or serious underlying disease.  It is very uncommon for patients to develop CDI without prior antibiotic use. Also at risk are patients who have frequent hospital admissions and prolonged and excessive length of hospital stays.

The Public Health Agency of Canada has collected data on healthcare-associated CDI (HA-CDI) through the Canadian Nosocomial Infection Surveillance Program (CNISP). This report describes the epidemiology of HA-CDI and the C.difficile strains types in Canada from 2007 to 2012.  The following are highlights of this surveillance report:

  • The overall HA-CDI rates in Canada peaked in 2008 but remained stable between 2009 and 2012.
  • HA-CDI rates per 1,000 patient admissions in adults showed no significant trend over time while HA-CDI rates per 10,000 patient-days in adults decreased slightly over the surveillance period.
  • HA-CDI rates per 1,000 patient admissions in adults varied by region.
    • The Central region had the highest rates with a slight decreasing trend over time.
    • The Eastern region had the lowest rates with a decreasing trend over time.
    • The Western region had the similar rates to the Central region; however, it showed no significant trend over time.
  • HA-CDI rates per 1,000 patient admissions in children were stable during the surveillance period while HA-CDI rates per 10,000 patient days showed significant increasing trends over time in children.
  • The all-cause mortality and the attributable mortality rates were stable in both adults and children populations.
  • NAP1 strain type remains the most dominant Clostridium difficile strain type followed by NAP4.

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